Incidental appendix neuroendocrine tumor and current treatment approach in patients with acute appendicitis

INTRODUCTION: The appendix is one of the common sites of neuroendocrine tumor (NET) which was formerly called as carcinoid tumor. It is mostly asymptomatic and incidentally detected after appendectomy or other abdominal operations. In this study, pathology results of patients which underwent operation for acute appendicitis and diagnosed as NET were evaluated.
METHODS: The files and pathology results of 586 patients which were operated for acute apandicitis in Recep Tayyip Erdoðan University Educational and Research Hospital between January 2015 and December 2016 were evalýuated retrospectively. The age, gender, histopathological diagnosis of the patients and the macroscopic tumor findings, tumor site, tumor size, surgical margin, Ki 67 index, mitotic index and subsequent treatments of the cases that was reported as appendicitis were evaluated.
RESULTS: 365 of the patients were male and 228 female. The mean age was 28.2 (1-88). Well differentiated NET was detected in three patients (0.5%). Acute appendicitis was not detected in the specimens of these three patients. The ages of the patients were 15, 35 and 48 years. Tumor sizes were 0.4, 0.6 and 1.2 cm. In all cases, the tumor was on distal site. The surgical margin was negative in two patients and positive in one patient. Ki 67 proliferation index was < 2% and mitotic index <2/10 Hpf in all three patients. Right hemicolectomy was performed in the first month after surgery in the patient with positive surgical margin. Two other patients were offered follow-up and discharged.
DISCUSSION AND CONCLUSION: It is difficult to diagnose appendix NET before histopathological examination. Life expectancy is well in these patients. However the possibility of development of synchronous or metachronous colorectal malignancies should not be forgotten.

Akut apandisit ön tanýsý ile opere edilen olgularda insidental apendiks nöroendokrin tümörü ve güncel tedavi yaklaþýmý

GÝRÝÞ ve AMAÇ: Apendiks, eskiden karsinoid tümör olarak adlandýrýlan nöroendokrin tümörlerin (NET) en sýk görüldüðü yerlerden biridir. Çoðunlukla semptomsuz olup apendektomi veya diðer abdominal ameliyatlar sonrasýnda insidental olarak saptanýr. Bu çalýþmada akut apandisit ön tanýsý ile apendektomi uygulanan hastalarýn patoloji sonuçlarý incelenerek NET saptanan hastalar deðerlendirildi.
YÖNTEM ve GEREÇLER: Ocak 2015 - Aralýk 2016 tarihleri arasýnda hastanemizde akut apandisit ön tanýsý ile opere edilen 586 hastanýn dosyasý ve apendektomi piyeslerine ait patoloji sonuçlarý retrospektif olarak incelendi. Hastalarýn yaþ, cinsiyet ve histopatolojik tanýlarý ile apendiks NET olarak rapor edilen olgularýn makroskopik tümör bulgu durumu, tümör yeri, tümör boyutu, cerrahi sýnýr, Ki 67 indeksi, mitotik indeks ve sonraki tedavileri deðerlendirildi.
BULGULAR: Hastalarýn 365' i erkek 228' i kadýn olup, yaþ ortalamasý 28.2 (1- 88) idi. Üç hastada (% 0.5) iyi diferansiye NET saptandý. Bu üç hastaya ait spesmenlerde akut apandisit tespit edilmedi. Hastalarýn yaþlarý 15, 35 ve 48 idi. Tümör boyutlarý 0.4, 0.6 ve 1.2 cm idi. Tüm olgularda tümör distal yerleþimli idi. Cerrahi sýnýr iki hastada negatif bir hastada pozitif idi. Her üç hastada Ki 67 proliferasyon indeksi % 2' den az ve mitotik indeks <2/10 Hpf idi. Cerrahi sýnýr pozitif olan hastaya ameliyat sonrasý 1. ay sað hemikolektomi yapýldý. Diðer iki hasta takip önerilerek taburcu edildi.
TARTIÞMA ve SONUÇ: Apendiks NET’ lere histopatoloji öncesinde taný koymak oldukca zordur. Yaþam beklentisi iyi olmakla birlikte senkron veya metakron kolorektal malignite geliþme olasýlýðý unutulmamalýdýr.